Recent Posts

Oct 2

Why Exercise Reminds Me of Cooking

I don’t know about you but every time I cook, I make a mess! Everything between prepping to plating leaves countertop, floors, cutting boards, and gas tops messy to some extent.

But none of this is surprising. We all expect to clean up after preparing a meal. And new recipes often mean there will be trial and error and not everything will turn out perfect.

As the new year embarks and you try joining a gym or taking a different fitness class, I think it’s important to view exercise in the same way that you would cooking a meal.

Not everything will work out, you may not like it, you won’t look pretty, you may have to modify things if you don’t have the right “ingredients”, and it won’t all go smoothly from the beginning. In fact, it might be a mess!

There will be a learning curve but you will become more proficient, learn what works for you, and in time, be able to produce the results you want. And, as with any meal, its always more fun to share than go it alone!

Oct 2

The Five Question Interview: Nutrition Therapist

With this regularly occurring segment to my blog, I hope to interview other practitioners, doctors, health club owners, athletes and really anyone who may have a valuable contribution to make to our understanding of the art and the medicine of physical therapy. I hope to keep it short and sweet, direct and informative. This interview was with Allison Topilow, a Nutrition Therapist, located in NYC and Westfield, NJ. Since we are what we eat, it is no surprise that poor nutrition can greatly effect a patient’s recovery. I appreciate Allison helping me understand some of the latest food trends and issues to keep in mind with my clients. Allison can be reached in her office @ 917-685-8791.

  1. When should a person seek out a nutritionist?

    I see clients for many reasons. I specialize in the prevention and treatment of eating disorders so many clients come to me because they are working through recovery from anorexia, bulimia, binge eating disorder or disordered eating habits. I also work with many parents concerned about their child’s weight or picky eating. Others are wanting a healthy pregnancy or dealing with medical issues including high cholesterol, high blood pressure, PCOS, and diabetes.

  2. What are some general guidelines to nutrition that are universally applicable?

    I believe in individualizing my recommendations for each client however two guidelines most likely to fit the general population include eating more fruits and vegetables and choosing whole foods (less packaged foods) when possible. I also recommend eating at home more often than eating out in restaurants or doing take-out.

  3. How important is it to incorporate exercise in meeting client goals?

    Very! I always emphasize the importance of nutrition, physical activity, and behavior modifications. Being active is healthy for our physical and mental health.

  4. Do you sometimes encounter patients who do not respond to your treatment approach and how do you manage these clients?

    As I mentioned above, I individualize my approach to meet the needs of each client. We continually discuss what is working and what might need to be changed to help each person meet their goals.  

  5. What are your recommendations for a patient that is taking in large amounts of protein or has a paleo based diet?

    I believe in a balanced diet that can be followed long term rather than a diet someone goes on and off over the years. I would discuss the pros and cons of a particular diet with my client and help them decide what is best for their lifestyle and goals.  

Mar 4

Do I really have to do my home exercise program?

Yes, you do.

This is often the most neglected part of physical therapy intervention. While manual treatments, neuromuscular re-education and ergonomic training gets all the glamour, the hard working and easily dismissed home exercise program (HEP) is often forgotten.

Physical therapy treatments have many layers. They address impairments such as pain and decreased mobility and strength. They address restrictions, such as difficulty using stairs or reaching backwards to fasten clothing. And they address function, such as returning to work or playing tennis. That’s a lot to cover.

But physical therapy treatments are not daily and often only 1-3 times a week. That leaves a lot of time in between for your body to forget your goals and return to dysfunction. Here is where the diligent and reliable HEP comes in to save the day.

Not only does it reinforce the exercises, stretches, and postural corrections you’ve been instructed on during your PT sessions, but it adds consistency to your week, retrains your body and helps you achieve your goals sooner! As you progress, so does your HEP, becoming more challenging and dynamic.

I’ve almost never seen a patient have good success if they did not adhere to the HEP. It trains the patient for independence once therapy has ended and establishes a good habit that will take him/her to the next phase of their health goals! So please, do your HEP every time!

Feb 12

Proper Foam Rolling Technique

Was just at the gym and saw so many people doing this incorrectly, it inspired me to post this short video.

Dec 18

The Five Question Interview: Plastic Surgeon

With this regularly occurring segment to my blog, I hope to interview other practitioners, doctors, health club owners, athletes and really anyone who may have a valuable contribution to make to our understanding of the art and the medicine of physical therapy. I hope to keep it short and sweet, direct and informative. This interview was with Dr. Farrokh Shafaie, a Plastic Surgeon located in NYC and Summit, NJ. What connection is there, you might be wandering, between a plastic surgeon and physical therapy? Read below and it will all come to light. Dr. Shafaie can be reached in his office @ 908-522-1777.

  1. What procedures do you perform that require post surgical “rehab” to return to full function?

    Abdominoplasties, breast enhancements and reductions, liposuctions, and face lifts are some of my most common surgical procedures.

  2. What advice do you give patients before surgery to ensure best outcomes?

    I advise them to start specific supplements associated with soft tissue healing one month before the procedure to be taken until one month after surgery. We strongly urge NO alcohol or smoking at least one month before or after the procedure. It is very detrimental to the healing process and results in poor outcomes. Also, no Advil or Aspirin 2 weeks prior to or after surgery. Healthy eating (avoiding heavy carbs and sugars) and staying active (not sedentary), as well as positive self imagery are all very important. The patient needs to see themselves as “beautiful” even before the procedure.

  3. How early should patients perform some sort of activity/exercise post treatment?

    • Post abdominoplasty, walk around next day or as soon as tolerated in compression garment, avoid lifting and bending for 6 weeks and then start light aerobic and core strengthening program with the guidance of a physical therapist. Typically, with this procedure, the abdominals completely shut down and it is imperative to learn how to use them again safely without injuring the low back or hip. The physical therapist can also advice on which gym exercises and group classes are the best to try and which ones to avoid.
    • Liposuction, 2 weeks post, start exercise with compression garment and increase as tolerated.
    • With face lifts, walk immediately but no high impact exercises up to six weeks to minimize swelling, then resume usual program.
    • Post breast augmentation, no activity involving chest and arms for 6 weeks and physical therapy after if needed to prevent stiffness and contractures in shoulder muscles.
    • Post breast reduction, patients can start all activity 3 weeks post-op without restrictions.

  4. What qualities do the patient’s who recover the best have in common?

    They are usually eager to return to exercise, not bed ridden, highly active, motivated to resume full lifestyle and less derailed by mild discomfort.  

  5. How has performing surgery affected you and have you had to seek physical therapy yourself?

    Yes, of course! Physical therapy intervention has helped me recover from shoulder tendinitis and deal with constant neck pain and stiffness. Long hours on the operating table have lead to forward head posture and back pain so I have to constantly counter that. I play paddle ball, take yoga classes and work with trainer regularly. Plus, I keep remembering to stand up straight, squeeze my shoulder blades, tuck in my chin and stretch whenever I can! 

Sep 25

Back To School

My older son just started middle school. As I watch him head off to school under the weight of a stuffed backpack, I cringe. I know he will only get more stooped for every block he walks and I imagine him slumping in his seat during each of his new classes. Without even a recess to break up all this sitting and bending, it a long day of bad habits reinforced by his current situation.

He has already dismissed my suggestion to try a rolling back pack, use a smaller, lighter binder and to wear the backpack closer to his body and higher on his back. All these would be hugely helpful, if actually utilized.

Because I can’t win these battles, I just implemented a few new rules at home.

  1. Homework is to be done sitting on a physioball or a low backless stool. Since the ball/stool is lower than a chair, it forces one to sit upright and use some core muscles to boot!
  2. When playing on the iPhone or reading for an extended period, children in our household must get into a prone prop up position for at least part of the time. That means on the floor, on their stomachs, propped up on elbows or pillows.
  3. If watching TV, the kids know to get up at every commercial break and do some back bends or stand on one leg in tree pose, reaching for the ceiling. The back bends (spinal extension) reverse the constant flexion activities of the day and the yoga pose is a wonderful stretch and reason to take a few deep breaths.

Of course these few tricks work for anyone. Think of them as damage control for our imperfect lifestyles. Until we figure out how to stop the stressors in the first place!

Jul 23

Your Post Physical Therapy Guide

Congratulations! You just “graduated” from physical therapy. Hopefully, this was a mutually agreed upon parting with your therapist based on successfully achieving your functional goals. Or maybe, it was because you reached a plateau or maximum benefit had been achieved.

Regardless of the reason, in the end, you need to have a long term game plan. The conclusion of therapy is NOT the end of your rehabilitation. Therapy gets the process started and lays the groundwork for success but what you do afterwards determines your final outcome.

So, how do you thrive on your own instead of ending back on the treatment table?

STEP ONE: Discharge plan. Your last few sessions with the therapist should concentrate on establishing an exercise routine that you can follow for the early weeks and months following discharge. I like to give my patients a 20-30 minute routine of familiar exercises that they can perform 4x/week at home and gradually work on increasing in intensity or duration under prescribed guidelines. This program should be challenging and effective.

STEP TWO: Integration back to community programs. If you are interested in returning to your local gym, taking a fitness class or trying something new, discuss this with your therapist. Is Pilates or Yoga the best class to try? Would swimming or water exercises minimize your pain? How does one start running safely and prevent injury? What modifications should you make? Interested in working with an athletic trainer or instructor? Ask your therapist. Most of us have a large network of professionals we trust and can guide your selection process. Even more importantly, when we advice you on what NOT to do, please listen to this advice. I would never keep a client away from an activity they enjoyed if I truly believed their was any other alternative.

STEP THREE: Return to sports. If you are returning to a sport, you should have practiced some of the necessary skills required to perform the sport in PT. For instance, plyometrics, coordination and balance drills, simulated movements and impact loading are some examples of therapeutic activities that replicate skills required in most athletic competition. You should also have a clear understanding of when you are allowed to resume your sport and what limitations you need to observe. This might mean abbreviated play, wearing a brace or taping a joint, using an orthotic, not participating in some drills and icing immediately after a game.

STEP FOUR: Long term modifications. If you really want to keep your pain at bay and prevent re-injury, this is a must. So correct your ergonomic set up at your computer, follow your therapist’s advice on driving, sleeping position, reaching, lifting, sitting posture and walking modifications, including the use of assistive devices. Stop staring at your smart phone and stop making excuses.

STEP FIVE: MOVE. Do something, even if its a little bit everyday. Do not let the long journey to healing deter you. Will yourself every day to keep at it and seek others who are like minded. Remember to stack the deck in your favor. Lose weight if you need to, get your nutrition in order, drop the bad habits that may be factoring into the equation. Be patient. And remember, you can always check in with your therapist if you need a boost. We are your biggest fans.

May 28

Why I Garden

  1. To get down, down, all the way down (to the ground). Studies show that adults, especially as they age, have decreased fall risk and better balance, proprioception and strength if they are able to get to the floor and back up independently. So, if you have started avoiding the floor, rethink your game plan. If joining a yoga class or gardening on your own is too intimidating, work with a professional until you regain this basic and very important skill.
  2. Bend, stretch, reach, repeat. Unavoidable when you are planting, weeding, mulching, composting and pruning. Not that different from a squat, lunge, chest press combo. Just make sure you are as careful and conscious of your posture and body mechanics during household activities as you are in a strengthening class. Also, timing is everything. You don’t work out for 3 hours straight, so don’t garden that long either.
  3. Being outside is good for your muscles AND your mind. Just be smart about when you are outside. Middle of the day in the heart of summer, not such a good idea. You don’t want to overheat or get a sunburn. Take advantage of cooler temperatures to be outside and it is completely energizing and invigorating! Plus, exercising outdoors ( which includes gardening) has been shown to elevate mood, improve memory and sleep and reduce stress and anxiety.
  4. Burn calories, grow something ( good now, good later). All that walking, digging, tool use, squatting and kneeling stimulates metabolism, burns calories and can be integral to staying fit. Plus, not many activities have the added benefit of bringing huge sensory enjoyment from growing sweet smelling flowers or big juicy tomatoes! So enjoy now AND later.
Mar 13

The Five Question Interview: Wellness Advisor

With this regularly occurring segment to my blog, I hope to interview other practitioners, doctors, health club owners, athletes and really anyone who may have a valuable contribution to make to our understanding of the art and the medicine of physical therapy. I hope to keep it short and sweet, direct and informative. The following interview is with a woman who fits into many categories. Jen Andretta is a Wellness Advisor, Nutrition Consultant, and Owner of Paragon Athletic Club. So I asked her about her expertise in all these areas as well as how to a patient might transition from physical therapy into a healthy lifestyle incorporating exercise and nutrition. Read on!

  1. You do so much!  Why do you have your ball in so many different courts?

    Yes, I wear a lot of hats, but they all have a theme...health and wellness.  Helping change the world by showing others how to live healthfully and happily is my passion, purpose and TOP priority.  Lots of new balls or hats come into my life and if they don't contribute to my mission then I can't take them on!  A girl can only juggle so many balls...gotta keep my priorities in check!

  2. How is your approach different than typical coaching?

    Honestly, I ask WHY a lot.  People come to me wanting to look and feel their best many times after a lot of failed attempts.  What I do different is really help my clients understand why they want to change and why they haven't so far.  I offer solutions not "quick fixes"...it takes work but is soooo worth it. 

  3. Can your clients achieve “success” if they are not integrating fitness and diet?

    Using just nutrition will get most a decent amount of "success"; however, incorporating fitness into the mix the success is much greater...think amazing six pack abs!  I like to meet people where they are.  If they can't commit to fitness at the moment, I get it.  Diet is 80% so I'd rather focus on that until they are ready.  The same is not true when someone focuses all their attention on fitness and not enough on nutrition.  

  4. What are the top 3 things you would advise for a client who is constantly getting injured with activity or when working out?

    Switch your workout.  If you're doing a high intensity workout, take it to low intensity.  You don't have to run full speed on a treadmill to get results...walk at a quick pace on a high incline.  If inflammation is an issue then I would suggest a nutrition program geared towards decreasing that. 

  5. What counsel would you have for a patient who has just completed physical therapy and is hesitant in getting back into the gym or someone who has never participated in an organized fitness routine before?

    First, I would say way to go on completing your PT.  Second, get a trainer that is certified in post rehab fitness.  You may only need a few seasons of them showing you different workouts to feel comfortable enough to do it on your own.  Also, find a gym that "feels" right to you.  If you're uncomfortable surrounded by fitness gurus then try finding a smaller local gym (such as mine, Paragon Athletic Club in Linden) where you get more of a family feel.  A final option is to try group classes (as long as your doctor clears you).  A class like Zumba or Yoga or a barbell class is a fun way to get fit with some like minded friends.  And yes...get a friend to workout with you!!! 

January 23

My Favorite Things

In preparing to give a presentation to a woman’s group recently, I was debating how to cover the large number of topics I wanted to discuss without turning the lecture into a 2 day workshop. I finally decided to call it “Physical Therapy Hacks to Improve Posture, Learn Relaxation and Strengthen Everything”. Kind of ambitious, I know, but really all I had to do was share my favorite ways to combat a few of the most common complaints/maladies I encountered with my patients daily. So, here’s some of what I came up with:

Stretching

Not a stretch at all but utilizing a foam roller to massage away all the post workout stiffness and prevent future soreness. See this diagram for some techniques to try.

Core Routine

Dynamic Plank. This means assuming plank position on hands, performing movements with arms or legs, possibly rotating the trunk, going down into forearm position or into downward dog/ prone press up. Any variation of these is great and just a few repetitions will have you sweating! This is one example.

Posture

When sitting, use a McKenzie pillow for better posture in deep chairs; when standing, keep legs in a stride position to minimize pressure on low back; when driving, sit a little closer to the wheel to decrease pull on sciatic nerve on right leg; when sleeping, use a body pillow and sleep on your side; when working on a computer, make sure the monitor is eye level!

Hip Exercise

Hot Potato

  1. Start, by laying down on your side on the mat.
  2. Extend your legs long, and bring them forward.
  3. Turn top leg out, pointing your toe outward.
  4. Tap your toe 8 times in front of bottom foot.
  5. Then, Raise your leg high into the sky parallel to your torso.
  6. Repeat, only this time tap behind your bottom foot, 8 times.
  7. Then, tap your toe 6 times in front, and 6 times behind.
  8. Repeat with 4, then 2, then 1 tap in front and behind each.
  9. Turn over and perform on other side.

Relaxation

Meeks Exercises

"Decompression Exercise": Lie on your back with your knees bent, feet flat on the floor. If your chin tilts upward, place a folded towel under the back of your head. Rest your arms by your sides about 45 degrees from your body, palms up. This position relieves compression in the spine and helps reduce back pain. Hold the position for a few minutes, breathing naturally. Perform DIAPHRAGMATIC BREATHING, allowing your lower abdomen to rise and fall for 8 counts.

  Remain in this position for each of the following exercises. Perform the movement, pause for a moment in the end position, then release and repeat 8 times.

  "Shoulder Press": Press your shoulders down toward the floor. Think of sliding the shoulder blades down and together, spreading the "wings of collarbones", stretching the front of the chest. 

  "Head Press": With head and neck in neutral position, press the back of the head into the floor (or towel) to strengthen the muscles in the back of the neck and help re-align the head over the shoulders.

  "Thoracic Lift": Do the Shoulder Press as above, only this time continue to press your shoulders down and lift the spine by arching your upper back off the floor. This strengthens the muscles between the shoulder blades and stretches the muscles of the chest and front of the shoulders.

"Elbow Press": Place your hands underneath your head, elbows wide. Press elbows down toward the floor. If your elbows don't touch the floor, place folded towels or pillows under the elbows so you have something to push against. If you can't get your hands under your head, start the exercise with your hands on your forehead and rest with them in this position. Don't press elbows back until you can get your hands behind your head.

"Leg Press/Lengthening": Straighten out right leg, pulling pelvis downward, lifting toes upward, pushing through the heel.  Push the entire leg down towards floor and hold a few seconds.  Repeat with left leg.

"Snow Angels": Spread arms and legs on floor as if making a snow angel on the ground. Go only as high as comfortable with arms.  

Pelvic Floor Routine

Never too early or too late to start these. During and after pregnancy leads to lower incidence of incontinence. Progress pelvic floor exercises from sidelying, to supine, prone, quadruped, sitting on ball, bouncing, performing exercises with weights, and finally to holding in urination mid cycle. Click on the link, The Truth About Kegels Exercises for information on technique.

Here are the basics from that article:

  • Start Position: Lie comfortably on your back on a firm surface. Keep your head relaxed. You may use a thin pillow or folded towel under your head if you like. Place one or two pillows under your buttocks. After a week or so try it without the pillows.
  • Bend your knees and hips keeping your feet flat on the ground, hip width apart.
  • Place two fingers of each hand on the top part of your panty line, just inside your pelvis.
  • Now, gently EXHALE and perform a pelvic floor contraction, as if you are trying to stop the flow of 1 or 2 drops of urine. Try to hold this contraction for 3 seconds. (Try slowly counting out loud, “O-n-e Mississippi, T-w-o Mississippi, T-h-r-e-e Mississippi”)
  • Relax. Then perform 3 quick contractions, where you gently contract then relax your pelvic floor, remember to gently exhale with each contraction. (Try counting out loud, “One – Relax, Two – Relax, Three – Relax”)
  • Now relax for 6 seconds.
  • Do each set 10 times in a row, 3 times per day.

It should feel as if your abdomen is gently drawing in towards your spine, not bulging outwards as you contract your pelvic floor muscles. Don’t force it by pulling your belly button towards your spine; let it happen naturally. Remember to be gentle! Less is more.

December 7

Function Follows Form

So, it turns out my home renovation is not quite over. Or even close. But, it has afforded me the opportunity to learn a LOT about all the complex components that go into finalizing a structure most of us take for granted.

From the plumbing, electrical and HVAC systems to the floors and carpentry, I have met so many skilled experts as they employ their craft towards a final vision. I’ve also noticed that the men ( there have been no women on the project thus far) that exhibit the most expertise and produce the most meticulous work are also the ones with the best “form” during their labor. The painters on the second floor of the house take the time to disembark from the ladder and move it every few minutes to ensure that they are not twisting and reaching but working mostly in front of them. The carpenter has rigged up a bench that accommodates his 6’5” frame so he is not bent over a low sawhorse. The flooring guys use knee benches and seats to protect their backs and legs. Even the sheet rockers wear short stilts to avoid over-reaching and keep moving! That really impressed the kids (and me). A core and balance workout while maintaining efficiency and control!

Conversely, sloppy positioning and form produced sloppy work. I don’t think this is a coincidence. It’s a fact in all aspects of life from the piano player to the runner and the mail carrier. To survive in an occupation or learn a task really well, one has to avoid injury, and over time will develop reinforcing positive postures and positions that enable even further skill attainment in the field of choice. I know this is true in my occupation as a physical therapist. I can generate a lot of “power” and endurance simply by the way I position myself and the patient. I’m not really that strong but I can make you believe I am and keep myself safe from injury at the same time. So whether working behind a computer or delivering them, please pay attention to form, and function will naturally follow.

October 24

The Five Question Interview: Athlete

With this regularly occurring segment to my blog, I hope to interview other practitioners, doctors, health club owners, athletes and really anyone who may have a valuable contribution to make to our understanding of the art and the medicine of physical therapy. I hope to keep it short and sweet, direct and informative. I was really excited for this opportunity to interview two personal friends, who I have always admired for their dedication to their training. While David is an elite athlete who competes professionally, Lisa is focused more on health/fitness and takes her commitment to exercise just as seriously. It’s amazing how similar both interviewees work ethic is despite their different goals.

First, a little background on David: The team he runs with is called Pearl Izumi Mid-Atlantic. Though small (fewer than 10 members), they came in 4th as a team in the 2014 Club National 10k Championships (it's the biggest open championship race run by the USA Track & Field Association) behind teams from Oregon, California and Texas. You can read a little more here.

David has personally finished in the top three in each of the past three NJ State 5k Championships over-40 division, with a 5k personal record of 16:13 as a masters runner ("masters," by the way, is what the USA Track & Field Association calls any runner over 40 years old).

So, with so many potential questions to ask, I couldn’t keep the interview strictly to just 5 questions, but did limit it to 5 general categories of questions. Hey, its my blog!

1 - How long have you been walking/jogging/running? When did you realize it was your preferred activity to maintain good health or the one you excelled at most?

David: I started running about six years ago. I ran cross country and track in high school, but then I took a 20-year break where I didn’t do much of anything except work. I got back into it primarily because I wanted to be outside more. I travel a lot for work and kept finding myself in nice places – like Seattle, San Francisco and Chicago – where I’d end up spending all my time in offices, hotels and taxis. I thought running would be a great way to see these places, so I spontaneously bought a pair of running shoes and shorts. Initially it was shockingly painful. My lungs were on fire, and my knees felt like they were coming apart. I actually thought I was fit, but apparently 20 years of inactivity is not good for the body. Despite the pain, though, I stuck with it and gradually increased my running mileage, from a mile or two initially to now 6 to 14 miles a day, six days a week (and obviously not just when I travel). After the first year, I started to set pace goals and got into racing, where I met other competitive over-40 runners who have kept me going.

Lisa: I have been doing some combination of walking/jogging for over 10 years.  I did not want to spend money joining a gym and I really enjoyed just being outside.  Moving this way seemed to be the optimal way to exercise because of the health benefits afforded when you challenge your heart rate this way.  It was in my hands when I went, how long I would do it for and how I would vary it.  I also felt most comfortable walking/jogging.  In the past, exercise classes or various machinery (excepting the treadmill) just didn’t quite feel as good

2- How do you stick to your training routine? Do you ever deviate, and if so, how do you get back on track?

David: Having goals has been important. I run with a team, and while we support each other I also feel peer pressure to perform well. We race seven or eight times a year, but really there are just one (or maybe two) big goal races in the spring and one or two in the fall that we focus on. I’ve stuck closely to my training schedule because I’m worried about slipping and letting the team down. Looking back on it, I think having two primary goals a year has been perfect. It means I also get two breaks right after those goal races are done and the pressure is off momentarily before I slowly build up to the next one. I also think having a fixed routine has been important for my training. On weekdays I get up really early and run before anyone else in the house is up. I haven’t always been a morning person, but I like this routine. I have no chance to rethink whether I’m going to work out, no creeping dread in the afternoon knowing I’ll have to work out later. No competing priorities. I just get up and go, and then it’s done. I also think there’s some benefit to being half asleep when I leave the house. I put up less mental resistance. A side benefit is that the streets are relatively empty of cars, although you’d be surprised by how many other runners are out that early, at least in the summer months. When I run at 5:30 a.m. in Chicago along the lakefront, I literally see hundreds of other runners. That’s motivating, too.

Lisa: Psychologically, it is important to me to do my routine 3 times a week.  Any more than that could lead to my feeling oppressed by the whole thing and any less may not be as effective.  If we are away and I cannot do it, I resume as soon as we get back.  I feel like I cannot mess around with it or opt out because I know how important it is for one’s body and not doing it would create angst for me in that regard.  I want be to be healthy and optimize my chances to live long and well.

3- What benefits have you noticed over the years?

David: I haven’t had a physical in years, so I’m not sure about physical health, but I bet my heart is in much better shape than it used to be. My resting heart rate is below 40, for example, which I’ve learned from routine visits to the doctor. I also think I’m much more agile than I used to be. For one thing, my knees no longer feel like they’re coming apart like they did when I first start running. But to be honest, it’s really hard to tell what’s happening physically, because I’m at an age (mid 40s) when everything is supposed to be declining. I feel like, if anything, my running has forestalled internal aging. Physically, I feel at least as good as I did in my early 30s.The biggest benefit to me, though, has been to my sense of well-being. I enjoy competing, even just with myself. I love the feeling of being in good shape, running fluidly, and getting into a zone. I don’t really love how I feel at the end of races (which is usually delirious and close to vomiting), but a hard workout is fantastic. Pushing myself and feeling my body respond positively is a rush.

Lisa: I do have more endurance in terms of performing certain other activities like hiking and I do think it has helped with circulation.  Mentally, just having the time outside to think, say hello to people,  has also been good.  Knowing that I have made a commitment to exercise feels right.

4- How important is the right gear/ support group/ running partners?

David: I’ve never had an issue with gear and never given it a lot of thought, but I certainly think it’s important to have shoes and clothes that you’re comfortable using. One of the reasons I like running is that it’s so simple. Here’s, though, what I find indispensable: A quality pair of shoes that fit right, a GPS running watch, comfy shorts and shirts, and a vented jacket and running pants for the winter. For shoes, I recommend visiting your local running store and listening to them. When I started, I picked out my own shoes from a big box retailer, and while I thought they looked great, they didn’t feel great. A few months later, I went to the Westfield Running Company and they sold me a pair that felt much better and fit my running mechanics. I’ve been getting a new pair of the same shoes every four months or so for the past six years and have had no problems. Aside from basic clothes, the only other thing I rely on is a GPS watch. It beeps every with a beep and lets me know how fast or slow I’m running, which gives me just the amount of focus I need. Having running partners has also been important for me, but the schedule has been a challenge. My running partners are primarily my teammates, and the support they provide has been great. We also have an internal rivalry, which has been very motivating. If one of us has a breakthrough, the rest of us will work harder to catch up. I run with the team a couple times a month on average, but getting together isn’t always easy, and for me breaking my routine to accommodate their schedule has been a bigger problem. If my teammates and I were all on the same schedule and lived closer together, I’d definitely run with them more. It makes it more fun.

Lisa: I am a lone wolf exerciser.  Another person in the mix would distract me and mess up my groove.  That being said, I know for some others, having people to exercise with is a big motivator.  I think having the right clothing and footwear has to be key to avoid certain discomforts and injuries.

5- Have you ever been injured and how did you resolve the issue?

David: The biggest injury I’ve had has been a strained calf muscle. Generally I run hard (with high intensity) two days a week, easy three days a week and long (low intensity but draining) one day a week. This is a pretty classic recipe for racing and incidentally, is a great way to make running more interesting. However, I have on occasion gone too hard on the hard days without resting enough between them. On one particularly hard workout on a cold March morning, I felt a sudden twinge in my calf but kept running. I thought it was just tight, and I stretched afterwards, but the next day it hurt much worse. Despite not being able to walk without a limp, I tried running again, thinking I could work out the soreness. I only got a half mile from the house before I had to walk back. I ultimately took about week off with a lot of icing and Motrin. Since then, I’ve been much more careful about easing into hard workouts and doing them at a more moderate pace if I know I’m not yet in great shape (especially in March). The only other thing I’ve had a problem with are my tendons, where pain will crop up once or twice a year. I’ve learned that it’s usually due to inflammation associated with friction – the iliotibial band, for example, rubbing across my knee. When I first experience knee pain that wouldn’t go away, I bought a foam roller (basically, log-sized piece of hard foam, which my teammates told me I had to have) and rolled my lower thigh against it. The pain went away almost immediately. I think I’ve been lucky, but in all cases of tendon-related joint pain, I’ve been able to get rid of the pain within a day and never really had to stop running.

Lisa: I feel lucky to have not sustained any acute injuries.  I do have pain in my feet at times or an awful cramp but I just try to plug along and right now they have stayed at a certain manageable level.  If anything became too obstructive, I would seek help.

September 26

Back to the BACK

I’ve got a backache. Actually, its more than that. I have a constant, nagging pain in my lower back that isn’t going away. And I’m not sure if I can make the necessary changes in my lifestyle that will make a positive impact at this time. As a physical therapist, its hard for me to utter those words.

First, a little background information. Our family is in the midst of a major home renovation with most of the house exposed to its studs and beams. While this is exciting in theory, its mostly just disruptive in practice. My makeshift kitchen is just a bunch of train tables thrown together so I am constantly crouching. Boxes of cereal and bags of pretzels are all thrown in a bookcase that I have to twist to access. The tiny refrigerator doesn’t fit anything upright, so again the reaching and bending to access food and drink. Our bedrooms are cramped with boxes so I can only open my lowest dresser drawers with my toes. You get the picture.

Adding insult to injury, I have been lifting and carrying a lot of heavy items for several months now, not always in good form, I’m ashamed to admit. And finally, I haven’t been exercising anywhere near the amount I was prior to starting this project. Fewer runs, fewer Pilates sessions, less weight training and forget stretching. So, I set up the perfect storm for an injury to occur and it did not disappoint. I’ve got lower back pain, like so many of my patients and I have to slowly work to get rid of it. I know it will be longer than I want before I am pain free and harder than I thought to stick with my core exercises and stretches. I know I will have to give up watching Colbert Friday night so I can get up early on Saturday to make a Barre class. And I know I will have to re-organize (again) my makeshift living space, even a little to allow for less bending and twisting. This will be the hardest part of all. The small, insidious postures we assume throughout the day that come back to haunt us. I will try to practice what I preach and I will report back with my progress next time! Anyway, this renovation will be over soon, right?

Aug 30

The Five Question Interview: Doctor

With this regularly occurring segment to my blog, I hope to interview other practitioners, doctors, health club owners, athletes and really anyone who may have a valuable contribution to make to our understanding of the art and the medicine of physical therapy. I hope to keep it short and sweet, direct and informative. My first interview is with Dr. Joseph DeRosa, an internal medicine physician, located in Westfield, NJ. I wanted to better understand the circumstances under which a family doctor might prescribe physical therapy for his patients. Dr. DeRosa can be reached in his office @ 908.654.1190.

  1. What is the primary demographic of your patients?

    Westfield...and the surrounding communities of Scotch Plains, Fanwood, Garwood, Cranford, Summit & Mountainside (but...certainly not limited to these communities).  Our Practice is comprised of patients, generally 40 to 79...who desire high quality & comprehensive primary care...specializing in prevention, wellness & coordination of care.  In addition, our practice is quite small, and intimate, giving individual attention to each & every one of our members.

  2. How often do you refer patients to a neurologist, orthopedist, or other specialist for complaints of physical discomfort and how beneficial is this in your management of the patient’s condition?

    We refer often, and, our involvement in their follow up is quite useful.

  3. What particular complaints of patients makes you seek out the services of a physical therapist?

    Over use & ergonomic injuries, as well as rehabilitation & chronic discomfort. 

  4. With so much new data supporting the benefits of exercise for a variety of diseases from hypertension, CAD, diabetes, obesity, osteoporosis, anxiety, depression and certain cancers, how likely are you to prescribe monitored “exercise” for your patients for their ailments?

    Very likely, and, increasing

  5. Communication is so important in health care. is there such a thing as “too much information” when it comes to patients contacting you with questions/concerns?

    No. We try to get and provide as much information to our patients as possible, and, really draw them into the decision making process. 

July 25

Exercise Equipment Tips

I like to challenge myself and my patients. I love to utilize all the equipment out there that makes workouts and rehab more fun as well as more effective. But there is always inherent risk to pushing oneself to the “next level”. To avoid injury, its important to remember a few safety guidelines with some of these popular gadgets/tools that many of us are using now.

  1. Therabands: These are great for dynamic resistance throughout a movement. Watch out for fraying and don’t pull so hard that they will snap! Also don’t underestimate the resistance- exercises with bands are as intense as with weights and can fatigue you.
  2. Free Weights: Love the versatility, but if you’ve ever dropped one of these on your feet, you know exactly what to watch out for. They can get slippery when you are working hard and sweating. And please, don’t swing these around. If you’re using momentum and arching/twisting/bending your back when you should be simply moving your arms, you are more likely to injure something before you strengthen anything. Movement should be slow and controlled and concentrated on the muscle groups being worked, as with any exercise.
  3. Stretch out straps/ Foam Rollers: Being too aggressive with your stretching is as bad as overdoing it with your workout. A muscle needs to be lengthened only until a comfortable stretch is felt. More is not better and can actually cause reflexive tightening due to discomfort/pain. Also, active stretching or foam rolling before a workout and slow, static stretching post workout is the way to go to optimize muscle firing and prevent soreness and injury. When using foam rollers, don’t move rapidly over an entire muscle group but slowly, spending time in a small range and on direct pressure points to release them.
  4. Physioballs: I once saw an experienced athlete fall off one of these, land on her arm and sustain a wrist fracture. Be careful when sitting, lying, kneeling, or arching over a ball. Learn how to safely get on and off for ALL your physioball exercises. Most of the time, this involves using your hands, arms and knees- not your back or abs. Often, I modify the technique for patients so its best to have a professional show you. Also, size matters. If you are on a ball that is too big or small, you will be improperly positioned and not targeting the right muscles. Lastly, remember that an overinflated ball is dangerous! It will not conform to your body and will roll away much easier. And, chasing a physioball is not a good workout!
  5. Treadmills: Get off the phone. Start slowly. Look ahead, not down at your feet. Keep hands off the bars. Put the emergency strap around your wrist if you are just starting out. Stay near the front of the treadmill. If you are sliding back, SLOW DOWN. Treadmills are great if you can’t walk/run outdoors but have a learning curve and one should always be careful when using them.
  6. Bosu Balls: Like the physioball, bosu balls are great for balance and core strengthening. There are two sides to a bosu ball with the flatter side being easier than the rounded, softer side. Start easy if you are going to attempt to stand on the boss for squats or balance exercises. Also, stand near a bar or wall so you can steady yourself if necessary. Spend a few minutes working on it at first and increase with additional exercises/time as you become comfortable. Finally, be careful when lifting and turning the bosu- its heavy!
June 21

Rehabilitation Following Injury

Physical activity has many benefits, from improved mobility and strength to decreased depression and fall risk. But sometimes, even the most cautious person can get hurt. It may be an innocuous trip off a high curb, a full day of gardening or maybe lifting a heavy bag into an overhead luggage bin. Luckily, most minor trauma is self resolving. However, if the pain lingers more than a few days, try asking yourself some questions to see if you should attempt self management of symptoms or seek consultation with a professional.

When to seek a doctor:

  • trauma requiring stitches, x-rays or casting
  • loss of bowel or bladder control
  • numbness and weakness in extremities
  • any emergency situation when you are exhibiting signs of stroke, heart attack
  • acute episode of vertigo

When to seek a therapist:

  • pain or dysfunction that is worsening with activity/exercise and not resolving after 2 weeks
  • radicular or shooting pain in one extremity
  • pain that is limiting motion, resulting in altered gait or body mechanics
  • pain that is limiting activities of daily living, such as climbing stairs, getting out of a car, putting on a jacket, etc
  • post any orthopedic surgery, once cleared for rehabilitation

When to try exercise:

  • occasional pain that does not worsen with activity
  • soreness and discomfort after activity but no other symptoms
  • difficulty performing a particular sport or embarking on a new activity such as running

If physical therapy is warranted, find a good therapist. In NJ, Direct Access allows patients to be treated for up to 30 days without a doctors’ prescription, so you can get started right away! Committing fully to getting better will ensure that you progress as quickly as possible through the rehabilitation process and can get back to the activity of YOUR choice.

Steps to rehabilitation:

  1. Manage pain with relaxation exercises, breathing, modalities, manual techniques, alterations to ergonomics, education, curtailing some activities
  2. Restore mobility and flexibility with joint mobs, MFR (myofascial release), MET (muscle energy techniques), and other osteopathic approaches
  3. Begin retraining muscles to address imbalances with limited, specific exercises
  4. Progress to moderate exercise. When patient has achieved close to 80% restoration of function and resolved pain, transition to HEP where patient can be monitored
  5. Begin lifelong journey to better health and fitness and avoiding re-injury through whatever means you find works

Don’t underestimate the importance of this last step. Finding a structured exercise program that you are passionate about will enhance your golf/tennis game, help you run faster and longer distances, allow you to keep up with your grandkids and help you avoid falls. No matter what fitness fads come and go, strength training is always in fashion because it works.

May 17

If The Shoe Fits

As many women know, buying the right shoes involves considering many different components. There’s function, style, budget, comfort and season. With the warmer weather recently arrived, we are well into summer sandal season and they are everywhere! If like me, you’ve sworn that this year, you will not fall victim to another cute, trendy and completely unsupportive sandal that tortures your feet, then read on. I’ve done some research and the tips below really helped me stay focused during my shopping trip.

  1. Avoid a pointy, super-narrow toe-box. The less space for toes, the greater chances of developing bunions and neuromas—and the more pressure is placed on toes when you’re upright.
  2. Opened-back, slide-on footwear ( i.e. flip flops) requires toe gripping that can lead to hammer toes and foot tension. Find a style with straps that keep the shoe attached to your body so your toes do not have to work.
  3. If your ankles wobble with each step, you need either more hip strength or a better-shaped heel. Wedges, platforms and lower chunky heels can give the appearance of height with more cushion, because they spread out the impact of each step, causing less pain without being frumpy.
  4. You don’t need to sacrifice fashion. Taryn Rose, designed by a podiatrist turned shoe designer, produces foot-friendly, high end but comfortable high-fashion shoes. Ferragamo has also ventured successfully in the less sky high but more comfortable market. Brands associated with comfort and performance are always a good bet if you are unsure where to start. Think: Tieks, Sofft, Aerosoles, Birkenstocks, Ecco, Mephisto, Dansko, Born and Clarks. Take a look at The Walking Company for some ideas. The new “comfort shoes” are seriously stylish!
  5. Finally: Nine out of 10 women are wearing shoes that are too small. The consequences aren't pretty – calluses, blisters, bunions, corns, and other problems. The constant rubbing can irritate the joints in the foot and lead to arthritis. Make sure you are properly fitted so you can look fabulous and feel it too!

So what did I opt for? The Birkenstock Gizeh because the cork has excellent shock absorption, plus the design offers good arch support, a wide toe box, a deep heel cup and a soft strap that won’t give me blisters. I also picked up a low wedge with an espadrille heel for shock absorption. Plus, since I’m usually on my feet all day, the thick arch and chunky heel make it safe to walk in.

Apr 26

On the Run Again

I’ve never seen so many runners on the streets. The old familiar faces are back now that the long winter hibernation period is over for us recreational runners, but there are lots of new ones as well. As I smile and wave hello, I can’t help but thinking “This is great but how many will last?” So, in the interest of making it last, here’s my advice both as a physical therapist and as a moderate distance runner myself.

  • Remember the basics: If you took a break from running (or any exercise) for more than 3-4 weeks, start slow. This means less mileage and slower speed. How old are those sneakers? If they’ve logged more than 400 miles, it’s time for a new pair. And don’t forget the importance of proper hydration (it’s getting hot out there) and diet (heavy meal = awful run). If you’d like to take up running but are not sure how, The Couch to 5K program has a manageable schedule that gets the job done.
  • Warm up and Cool Down: That means dynamic movements like lunges, squats, high knees, leg swings before and foam rolling and slow static stretches afterwards. You will not only get a better workout with reduced muscle soreness but help prevent injury so you can keep running!
  • That road is CANTED! Running the same route means that you are probably pounding the same slanted asphalt over and over again. It’s not only boring but can cause foot and calf ligament/muscle strain. Find several different routes and surfaces to run on. Avoid concrete as much as possible.
  • Rock Out: Studies show people who listen to music while exercising run harder. Invest in good earbuds,an arm band or clip for your smartphone so you’re not holding it in your sweaty palms.
  • If it’s not working, you can try bringing a friend into the mix: Maybe you just need the support or the social shaming. Or, try fast paced walking instead. All the health benefits and you can still hold a conversation!
  • Finally, Rest and Recovery are vital: Take a couple of days off during the week so your muscles and joints can recover from the micro damage and produce stronger, more efficient contractions on the next run!
March 28

Spring Sprains and Strains

I know the Spring Cleaners are going to be coming out in the next few weeks. And that means, so are the “March maladies”. The backaches and shoulder sprains and swollen knees. All the twisting, bending, lifting and kneeling is the means to an end, and not often taken into great consideration prior to beginning a task. But it should be. When you deliberate on what needs to be done, take a few minutes to figure out HOW to do it. The BEST way to do it. The least likely to send you to a therapist for help. By now, everyone should know to bend at the knees, hold objects close to the body when lifting and not to twist but pivot instead, when turning. Here’s a few additional tips I’ve found useful:

  1. Break it up: Don’t do it all in one day or even one weekend. Switch around activities- a little time in the attic, a little in the garden. Take a coffee break, stretch, go for a walk. Repeat as needed.
  2. Get the kids and spouse involved: You are not alone. They want to help in there own incompetent way. Getting it done sort of right is better than not getting it done at all because you are injured.
  3. Use tools and gadgets whenever possible: I love garden benches for weeding and planting and even picking up lawn debris. Ditto for “reachers” when dusting hard to reach places. Wheelbarrows haul a lot of stuff. Small baskets for carrying loads up and down the stairs ensures you won’t lift more than you should.
  4. Quit while you're ahead: A few hours of cleaning and you finished laundering all the winter blankets, coats and snow gear? Great! Celebrate by rewarding yourself and get to the rest another day.
  5. You still have to exercise: Alas, cleaning and sorting does burn calories but you can’t stray too far from your fitness routine! Keep strength training, aerobic conditioning and participating in your sport of choice so you don’t get injured when you attempt to resume after taking too much time off.

If you do get injured, don’t suffer! Get to a therapist sooner rather than later. The longer you have a dysfunction, the longer it takes to resolve it. And really, who has the time?

March 15

Take a Stand

Everyone in marketing knows that a sales call has a greater chance for success if the person behind it is standing and smiling. Why? Because, who can sound grumpy and tired with a big smile on their face? And even though we cannot see the caller, the energy projected in their voice from standing upright (versus hunched over a desk), the deeper, more confident voice coming from a fully expanding diaphragm and the hint of a smile in the caller’s speech is universally appealing. Sure, I’ll buy some of that!

Well, it turns out that there’s more to the equation. If you haven’t already, you must listen to Amy Cuddy’s TED talk regarding body language and power posing. This is an instance of body positioning not only affecting other people’s perceptions, but actually altering your own body chemistry until you are the confident person you did not know you were. Turns out you can power pose yourself to success in just 2 minutes. So the next time you need a boost, get up, hands on hips “Wonder Woman” style or arms up and out like in the picture above. And when you nail that interview, remember to tell everyone, it was your great posture that won them over.

March 1

Time for a Lesson

My family loves to go skiing. Well, almost all of us. My youngest son started out reluctant and remains just tolerant of the sport on most trips. A few weeks ago, things changed however. I thought it was just his improved attitude and all the practice from weeks before that propelled him to try an advanced trail and perform so well on it. But, when looking at some pictures after the trip, I saw the real reason. Posture- or in this case, stance. Look at his positioning in the above picture. Weight shifted back, one arm forward, the other behind, looking down at this skis- all wrong! How could he possibly perform a single maneuver if that was his positioning at the onset? Skiing was so difficult! When he finally started listening to our beseeching cries of “lean forward”, “hands on knees” and “look ahead”, things got dramatically better!

If only in everyday life, we each had a coach behind us saying, “feet flat on floor”, “shoulders down and back”, “take a deep breath and unclench that jaw”, maybe we would all see improvement of some kind. Fewer headaches, less neck and back pain, goodbye carpal tunnel. Never take posture for granted- its what allows for all the movement and flexibility needed to perform any of life’s tasks. And how well you perform them, will come back to how seriously you take your posture. More on posture and power next time.

February 16

Stuck in the Clinic

For too long, physical therapy has been stuck in the clinic. Patients get hurt or have surgery, go to the doctor, get sent to physical therapy for a few weeks or longer and are discharged “successfully”. Only then do they remember that they never told the PT about an upcoming move or that softball season starts in a month or maybe that reaching into the trunk of the car never really got better. Rehabilitation involves a continuum of care- from doctors office to physical therapy clinic and back in the home environment. Often, this continuum is abruptly ended with PT discharge. The clinic is not real life and real life is very different. After all, its impossible to come up with every scenario that a patient may encounter or even replicate the chair they use in a home office. But wouldn’t it be great if we tried? The most efficient way to do this is go directly into the home environment, whether thats a laundry room or a golf course. In a perfect world, the final sessions of therapy would consist of engaging the patient in whatever real life consists of- the activities that have meaning and the ones they continue to struggle with despite all our efforts in the clinic. Everything in medicine is trending towards highly individualized care whether its in the battle against cancer or replacing joints. Physical therapy should be no different- it should be leading the pack. Only once we know that we’ve guided the patient through the full continuum of care, can we claim success.